"*" indicates required fields URLThis field is for validation purposes and should be left unchanged.Family InformationFather's Name First Last Father's PhoneMother's Name First Last Maiden Mother's PhoneStatus of Parents*Choose OneMarriedSeparated / DivorcedOtherAre parents registered at Our Lady of Mercy?* Yes No At what parish are the parents registered?Name(s) of person(s) to receive mailed information*Click the ‘+’ to add more Add RemoveMailing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Name(s) of person(s) to receive Electronic information*Click the ‘+’ to add moreNameEmailText Message Address Add RemoveEmergency Contact Name* First Last Relationship to Child*Contact's Phone Number*Sacraments Received Has Received No Sacraments First Communion Confirmation Registration Fee One Child – $125.00Two or More – $175.00 Family Fee* Parishioner Non-Parishioner Tuition* 1 Child 2 Children 3+ Children TotalStudent InformationIf your child is entering Grade 1 or is new to our program, we need to have a copy of his/her Baptismal Certificate unless he/she was Baptized at Our Lady of MercyStudent InformationNameGradeBaptism Date & Parish (City, ST)Eucharist Date & Parish (City, ST) Add RemoveDo any of the students have any medical conditions we need to know?Please include the name of the student and medical condition if applicableCAPTCHA
